Active surveillance safe for mRCC patients with slow-growing disease
Some patients with metastatic renal cell carcinoma (mRCC) who have slow-growing disease can safely undergo active surveillance for months to years before starting systemic therapy, a small phase II study has shown.
In patients with favourable prognosis (n=29) who had ≤1 International Metastatic Database Consortium (IMDC) risk factor and ≤2 organs with metastatic disease, the median time on active surveillance from study entry to start of systemic therapy was 22.2 months. [Lancet Oncol 2016, doi: http://dx.doi.org/10.1016/S1470-2045(16)30196-6]
In contrast, median time on active surveillance was 8.4 months for those in the unfavourable prognostic group (n=19), which comprised all other patients in the study.
“The median time on active surveillance was 14.9 months in the 48 patients included in our analysis. Their overall survival from the start of surveillance was 44.5 months,” said lead author Professor Brian Rini of the Cleveland Clinic Taussig Cancer Institute in Cleveland, OH, US.
The prospective study included 52 patients with treatment-naïve, asymptomatic mRCC from five hospitals in the US, Spain and UK. Patients underwent CT scan of the chest, abdomen and pelvis at baseline, every 3 months during year 1, every 4 months during year 2, and every 6 months thereafter to assess tumour burden and time to disease progression. The decision to initiate systemic therapy was made at the discretion of the treating physician and patient.
During a median follow-up of 38.1 months, 43 patients (90 percent) experienced disease progression. Among those with progressive disease, 20 patients (47 percent) chose to continue on active surveillance (median additional surveillance period, 15.8 months), and six patients remained on surveillance at the time of paper submission.
Patients with disease progression most commonly experienced growth in existing sites of metastases (n=32; 74 percent). Eight patients (19 percent) had new sites of disease, while three (7 percent) had both worsening of existing sites and new sites of metastases.
“Our results show that mRCC patients with limited sites of metastatic disease and few adverse prognostic factors can safely be managed with active surveillance, which could spare them the inconvenience and debilitating side effects of aggressive treatments for about 1 year, and in some cases several years, without worsening anxiety and depression,” said Rini.
“Quality of life, and anxiety and depression scores did not change substantially over the surveillance period, suggesting that living with untreated cancer did not cause psychological harm to mRCC patients in this study,” he added.
“This paper provides guidance to both medical and surgical oncologists ... There is no evidence from this study that such a period of close surveillance jeopardizes the patient’s safety or survival,” wrote Dr. Paul Russo of the Memorial Sloan Cancer Center, New York, NY, US, in a linked comment. [Lancet Oncol 2016, doi: http://dx.doi.org/10.1016/S1470-2045(16)30247-9]